Problems posed by misinformation, poor communication, fear of public inoculation program

BUFFALO, N.Y. -- A study about whyAfricanAmerican seniors do or do not get influenza vaccinations finds that many of them do not have accurate and complete information about the flu itself, the safety and efficacy of the inoculations, and the ease and necessity of getting the shots.

Co-author and health communications specialist Lance Rintamaki, PhD, assistant professor of communication at the University at Buffalo, says that in addition, misinformation about the notorious 1932-72 Tuskegee syphilis studies ofAfrican-American men may result in a lingering distrust of some public health inoculation programs.

The study was published in Health Communications.

It notes that, despite the risk of influenza-related medical complications among those 65 years and over, AfricanAmerican seniors are less likely to be vaccinated against flu than are non-Hispanic white seniors.

Rintamaki points out that, although the U.S. Department of Health and Human Services wants to have 90 percent of seniors vaccinated, the vaccination rates for American adults 65 years and over averages 65 percent -- but is only 48 percent among older African Americans.

This is of great concern in the medical community, he says, because 44,000 Americans 65 and older die from influenza and its complications every year, compared to a total of 7,000 flu-related deaths in all other age groups.

According to Rintamaki, the researchers found several reasons for the reluctance of AfricanAmerican seniors to get flu shots.

"One," he says, is that study subjects did not understand how often they need to be vaccinated. Some seniors thought that, like vaccines against common childhood illnesses, the flu vaccine provided lifelong protection against the flu. Many did not know they needed to be re-vaccinated every year.

"The participants knew there are different strains of influenza," he says, "but they didn't realize they needed to be vaccinated against each strain as it turned up.

"Some also thought -- as do many members of the public -- that the vaccines cause the flu. If they became sick with a virus of one kind or other around the time they had a flu shot," he says, "they drew the erroneous conclusion that the shot made them sick.

"This is a common misperception and one that needs to be corrected," Rintamaki adds. "We often tell people the vaccine doesn't 'cause' flu but in failing to address why they might assume that it does, we leave the door open for them to think they are avoiding illness by avoiding the vaccine."

The researchers say better and more targeted messages and interventions are necessary to address concerns specific to older African Americans and to emphasize how important it is for those in this age group to be vaccinated.

The study involved six focus groups of AfricanAmericanseniors in the Chicago area. Their average age was 75 and 85 percent of them were women. They were asked to identify their current perceptions about influenza and influenza vaccination.

Seventy-seven percent of participants said they had received the flu vaccine at some time in their life, but only 50 percent had been vaccinated the previous year.

Despite the group size and the fact that their responses cannot be projected to the community as a whole, the authors say the results of the study confirm those conducted by the Centers for Disease Control and Prevention and others.

Some disturbing news to emerge from the study, says Rintamaki, is that the infamous Tuskegee syphilis experiments continue to affect levels of trust among African Americans toward public health programs.

The Tuskegee experiments, whose original goal was to justify treatment programs for blacks, involved 399 AfricanAmericansharecroppers infected with syphilis. In 1932, when the study began, the available treatments were highly toxic and of limited effectiveness. The study aimed to determine if patients were better off if they were not treated with those remedies. The researchers also wanted to study the efficacy of specific remedies for individual stages of the disease.

By 1947, penicillin was commonly used as an effective cure for the disease. The researchers, however, failed to treat study participants with the medication. As a result, many men died of syphilis, wives contracted it from husbands and children were born with congenital syphilis. The study was not discontinued until news of this fact emerged, causing a public uproar.

Rintamaki points out that although the some of the seniors interviewed were not familiar with these experiments, those who were thought that the Tuskegee researchers did more than withhold treatment. They thought they actually injected the men with syphilis.

"The Tuskegee experiments have stirred fear and suspicion in the AfricanAmerican community over many health initiatives," he says, "and the suspicion they spawned has a continuing negative effect on the health of that community.

"In fighting the flu by encouraging inoculation, it is imperative that as health communicators we recognize that such fears exist and address such them," he says.

In addition to Rintamaki, the research team included Kenzie A. Cameron, PhD, research assistant professor, Division of General Internal Medicine, Feinberg School of Medicine Northwestern University; Mafo Kamanda-Kosseh, clinical coordinator, Center for Interventional Vascular Therapy, Columbia University Medical Center; Gary A. Noskin, MD, associate professor of medicine, Feinberg School of Medicine, Northwestern University; David W. Baker, MD, professor of medicine and chief of the division of general internal medicine, Feinberg School of Medicine, Northwestern University, and Gregory Makoul, PhD, vice president for academic affairs, St. Francis Hospital and Medical Center.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.